II. Indications: Skin flap closure (no vascular compromise)

  1. Y-shaped Laceration corners (90 degree angle)
  2. X-shaped Laceration

III. Advantages

  1. Does not compromise blood supply to tip of corner

IV. Technique: Y-shaped lesion

  1. Background
    1. Use non-Absorbable Suture
    2. Draw line perpendicular from corner tip (forms Y)
    3. Four landmark sites (2 on each side of the wound)
      1. Point 1 along left base of Y (6-8 mm from corner)
      2. Point 2 at left upper arm of Y (4 mm from corner)
      3. Point 3 at right upper arm of Y (4 mm from corner)
      4. Point 4 along right base of Y (6-8 mm from corner)
    4. Images
      1. sutureHalfBuriedHorizontalMattressLabel.jpg
  2. Step 1: Skin entry to base of flap
    1. Enter at point 1 on left side of wound
    2. Needle passes deep, below Dermis
    3. Exits subcutaneously near Point 2
    4. Exits at point 2 on left side of wound
  3. Step 2: Subcuticular stitch through flap
    1. Continue stitch started in Step 1
    2. Enter wound at point 2 on left side of wound
    3. Pass subcuticular stitch in flap to point 3
  4. Step 3: Flap to skin exit
    1. Enter near point 3 still subcutaneously
    2. Exit skin at Point 4
  5. Step 4: Tie knot
    1. Knot is between point 1-4 across base of Y
    2. Tie snugly, but avoid tying too tightly
      1. See complications below
  6. Step 4: Final appearance
    1. Suture exposed between point 1 and 4

V. References

  1. Mortiere (1996) Wound Management, p. 50-5
  2. Snell in Pfenninger (1994), Mosby, p. 12-9
  3. Zuber (2002) Am Fam Physician 66(12):2231-6 [PubMed]

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window